Hwang et al. Allergy Asthma Clin Immunol (2016) 12:5 DOI 10.1186/s13223-015-0108-7
Allergy, Asthma & Clinical Immunology Open Access
SHORT REPORT
Association between allergic rhinitis and metabolic conditions: a nationwide survey in Korea In Cheol Hwang1, Yong Joo Lee2*, Hong Yup Ahn3 and Sang Min Lee4
Abstract Background: Accumulating evidence indicates a strong correlation between allergic disease and cardiovascular risks. In spite of this, the data concerning the association between allergic rhinitis (AR) and cardiovascular risks is sparse and conflicting. This study aimed to investigate the association between AR prevalence and metabolic syndrome (MetS) in a large-scale, population-based survey, while considering the relevant risk factors. Methods: A nationwide cross-sectional study was conducted based on data from 30,590 subjects aged 19 years and older, from the Korean National Health and Nutrition Survey 2007–2013. The odds ratios (ORs) and 95 % confidence intervals (CIs) of AR prevalence, based on MetS status and the presence of any MetS component, were calculated using multiple logistic regression analyses. Results: Regarding the characteristics of patients with AR and/or MetS, some variables had significant associations with disease in inverse directions for AR and MetS. Multivariate logistic analysis, with adjustments for demographic variables and health habits, indicated that AR prevalence was significantly lower in subjects with MetS (OR 0.84; 95 % CI 0.76–0.93), high blood pressure (OR 0.85; 95 % CI 0.77–0.94), or impaired fasting glucose (OR 0.81; 95 % CI 0.73–0.89). Furthermore, high blood pressure and impaired fasting glucose were significant predictors for reduced AR prevalence, independently of other MetS components. Conclusion: In this population, AR was diagnosed less frequently in subjects with metabolic conditions. Welldesigned prospective studies allowing for medical service utilization and collaborative basic research are warranted to elucidate the mechanism responsible for this inverse relationship. Keywords: Allergic rhinitis, Cardiovascular risks, Metabolic syndrome, Impaired fasting glucose Background Extensive studies have revealed that asthma patients are at greater risk of cardiovascular disease (CVD), with multiple mechanisms proposed [1]. Allergic rhinitis (AR) is believed to be an intermediate state between the normal healthy condition and clinical asthma [2], and it has been shown that individuals with AR are at greater risk of developing asthma [3]. AR has been suggested to be associated with CVD risks in a similar fashion [4]. The *Correspondence:
[email protected] 2 Department of Family Medicine, Seoul St. Mary’s Hospital, The Catholic University College of Medicine, 222 Banpo‑daero, Seocho‑gu, Seoul 137‑701, Republic of Korea Full list of author information is available at the end of the article
basis for this potential association is that individuals with significant AR symptoms are more likely to be habitual snorers, which then leads to higher blood pressure (BP). But, the findings of previous studies examining BP of AR patients are conflicting [5, 6]. Likewise, inconsistent results have been obtained with regard to the influence of AR history on CVD. In a prospective cohort study, participants with a history of hay fever had an adjusted hazard ratio of 1.87 for a stroke versus those without hay fever [7]. However, a recent nested case–control study demonstrated that AR patients were at lower risk for CVD [8]. The differing age of onset of AR and CVD, may complicate the relationship between them. The prevalence
© 2016 Hwang et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Hwang et al. Allergy Asthma Clin Immunol (2016) 12:5
of AR is highest in the second to fourth decades of life, and then gradually diminishes; this is in contrast to the prevalence of CVD, which increases later in life [9]. It is also well known that AR occurs frequently in subjects of higher socioeconomic class [10]. To reduce the fragmentation found in previous studies, we aimed to investigate the association between AR prevalence and metabolic syndrome (MetS) in this large-scale population-based study with a consideration of the relevant risk factors.
Methods Study design and subject selection
This study was based on data obtained from the Korean National Health and Nutrition Examination Survey 2007–2013, which was a nationwide population-based survey conducted by the Korean Ministry of Health and Welfare. Participants were randomly selected through a stratified, multistage, probability-sampling design according to sampling units based on age group from household registries as well as economic status, sex, and geographic area [11]. This study was approved by the Institutional Review Board of Gachon University Gil Medical Center. We identified 44,118 participants of 19 years of age or older. Of these, subjects who were diagnosed with overt CVD (stroke or myocardial infarction, n = 1192), other allergic diseases (atopic dermatitis or asthma, n = 2157) and those who had no available data on the two main variables (AR, n = 8072; MetS, n = 2107) were excluded. Thus, a dataset of 30,590 patients was used in the final analysis. Data processing
Information on demographic characteristics (age, sex, household income, residency, education level, occupation and marital status), health behaviors (physical activity, smoking history, and alcohol consumption), and history of disease as diagnosed by a physician (AR, hypertension, type 2 diabetes, and dyslipidemia) was collected during the health interview. Waist circumference was measured at the narrowest point between the lower border of the rib cage and the iliac crest. BP was measured from the right arm after the subject had rested for 5 min in a sitting position using a standard mercury sphygmomanometer (Baumanometer, USA). Blood samples were obtained after a 12-h overnight fast, and fasting plasma glucose, triglyceride, and high-density lipoprotein cholesterol levels were measured using a Hitachi 700-110 Chemistry Analyzer (Hitachi, Tokyo, Japan). The definition for MetS and its components was based on the National Cholesterol Education Program Adult Treatment Panel III guidelines, and we used the ethnicity-specific values for waist circumference based on
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data from the Korean Society for the Study of Obesity [12]. MetS was thus defined by the presence of three or more of the following criteria: central obesity (waist circumference ≥90 cm for men and ≥80 cm for women); systolic BP ≥130 mmHg or diastolic BP ≥85 mmHg; fasting plasma glucose levels ≥100 mg/dL; triglyceride levels ≥150 mg/dL; and low high-density lipoprotein cholesterol levels (
